12.10.03 The final countdown

Intussusception

• • Most commonly around ileocaecal valve

    • Loads of Peyers patches there

  • Red-current jelly stools

    • Pressure => venous obstruction => engorgement => blood loss

  • Pain comes from compression of the serosa of the inside bit

    • Pain fibres are in the serosa

  • DON'T bother doing an AXR

    • Much easier, quicker to see using US

  • Use AIR rather than barium enemas

    • c.f. risk of perforation

  • Frequency 1/300 - 1/350

    • Similar to pyloric stenosis

  • Secondary causes

    • Meckel diverticulum

    • Cancer

      • Commonly B cell lymphoma, in the bowel wall

    • Cysts

    • Polyps

Circumcision

• • Absolute medical indications

    • Phimosis secondary to balanitis xerotica obliterans

    • Recurrent balanoposthitis

  • Relative indications

    • Paraphimosis

    • Balanoposthitis and balanitis

    • Preputial “pearls” and redundant foreskin

    • Phimosis

    • Prevention of sexually transmitted infections?

      • Uncircumcised males are more prone to genital ulcer disease (syphilis, chancroid, herpes simplex) as well as infection with human papillomavirus

      • But circumcised men were more prone to urethritis

    • Prevention of HIV infection

    • Prevention of penile cancer

    • Prevention of urinary tract infection in boys with urological abnormalities

    • Trauma

Notes

• • 6 month old baby, obstruction?

    • Strangulated inguinal hernia (very common)

    • Intussesception

  • Give vitamin K to neonates

    • Otherwise they'll be bleedy up to about 8 days

  • If a bowel loop is wider than the vertebrae, it's distended

  • Triad of obstruction

    • Abdominal distension

    • Bilious vomiting

    • Not pooing

  • COMMONEST CAUSE OF OBSTRUCTION IS A STRANGULATED INGUINAL HERNIA!

  • NEC is a common cause of obstruction in a neonate

  • Posthitis is inflammation of the foreskin